A study of transformational change at three schools of nursing implementing healthcare informatics

277 Pages·2015·2.62 MB·English

University of South Florida
Scholar Commons
Graduate Theses and Dissertations Graduate School
3-11-2009
A Study of Transformational Change at Three Schools of Nursing
Implementing Healthcare Informatics
Revonda Leota Cornell
University of South Florida
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Cornell, Revonda Leota, "A Study of Transformational Change at Three Schools of Nursing Implementing
Healthcare Informatics" (2009). Graduate Theses and Dissertations.
https://scholarcommons.usf.edu/etd/1910
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A Study of Transformational Change at Three Schools of Nursing Implementing
Healthcare Informatics

by

Revonda Leota Cornell

A dissertation submitted in partial fulfillment
of the requirements for the degree of
Doctor of Education
Department of Adult, Career, & Higher Education
College of Education
University of South Florida

Major Professor: James Eison, Ph.D.
Michael Mills, Ph.D.
W. Robert Sullins, Ed.D.
H. William Heller, Ph.D.

Date of Approval:
March 11, 2009

Keywords: Higher Education, Eckel and Kezar (2003), St. Scholastica, University of
Kansas, electronic health record, IOM

© Copyright 2009 , Revonda Leota Cornell
Dedication
Although neither my mother nor my uncle will be able to celebrate with me in
their physical bodies, their spirits will always be intertwined with mine. To my mom,
Betty Crews Wyles, thank you for instilling in me the importance of an education. To my
Uncle Jimmy Crews, your valuable support and recognition throughout my life has been
a treasured gift.
I want to extend appreciation to all my friends who have patiently listened to my
personal stories, trials and tribulations as I progressed on my journey to complete my
doctoral studies. A special thanks to my friends Nancy Mills, Cathy Salas, and Julia
Larson, who encouraged me every step of the way as I wrote this dissertation.
Acknowledgements
I would like to express my gratitude to my dissertation committee, especially to
Dr. Michael Mills, my chair and advisor. He continually amazed me with his calmness
and endless patience through this challenging time of my life, and I will be forever
grateful. A special thanks to Dr. Bill Heller who assisted me in beginning my personal
journey to doctoral studies.
Finally, to the Deans of Nursing who supported my research at the schools of
nursing: I hope this research serves beneficial to your on-going transformational change
journeys.
Table of Contents
List of Tables ix
Abstract x
Chapter One: Introduction 1
Statement of the Problem 2
Theoretical Framework 5
Rationale 7
Cases Selected 10
Qualitative Research Questions 11
Research Design and Methods 12
Educational Significance of the Study 13
Limitations and Delimitations 14
Researcher’s Personal Biases 15
Organization of Remaining Chapters 16
Chapter Two: Review of the Related Literature 18
Synthesis of the Change Model Literature 18
Teleological Change Models 18
Evolutionary Change Models 19
Life-Cycle Change Models 20
Cultural Change Models 20
Social-Cognition Change Models 21
Political/Dialectical Change Models 22
Recommended Change Principles for Higher Education 23
Other Terms Commonly Used in Change Literature 24
Difusion 24
Institutionalization 24
Reform 24
Summary of Change Model Literature 25
Transformational Change 26
Definition 26
Differentiating Transformational Change 27
Adjustment 27
Isolated Change 27
Far-Reaching Change 27
Transformational Change 28
Other Types of Change Common to Higher Education 28
Innovation Implementation 28
Adaptation 28
Strategic Change 28
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Similarities 29
Disimilarities 29
Mobile Model for Transformational Change 30
Formulation of Model 30
Key Aspects of the Mobile Model 31
The Role of Sensemaking 31
Five Core Change Strategies 32
Fifteen Supporting Strategies 33
Institutional Culture 35
Types of Evidence 36
Structural Evidence 36
Attitudinal and Cultural Evidence 37
Observations of Transformation Within Organizations 37
Mobile Model of Transformational Change (2003) Cited in
Literature 38
Summary of Transformational Change Literature 39
Healthcare Informatics 40
Introduction 40
Strategy One: Common Language and Core Competencies 41
Definitions 41
Debate Over Broad-based Versus Discipline-Specific
Language 42
Professional Competencies for Nursing 42
Summary of Common Language and Core Competencies 43
Strategy Two: Integration of Core Competencies into Oversight
Proceses 45
Oversight Processes Defined 45
Nursing Oversight Agencies 45
State Nursing Licensing Laws 46
Regulating the Scope of Practice 46
Summary for Integration of into Oversight Processes 47
Strategy Three: Motivation, Support for Leadership and
Monitoring Progress 47
Supporting Partnerships Between Academic and Practice
Setings 47
Support Provided by Professional Organizations 48
Summary for Motivation, Support for Leadership and
Monitoring Progress 49
Strategy Four: Develop Evidence-Based Curricula and Teaching
Aproaches 50
Overview 50
Defining Evidence-Based Curricula 52
The Undergraduate Curriculum 52
Common Barriers to Informatics Curriculum Development 54
Existing Models for Nursing Informatics Curriculum 54
ii
Collaborative Partnerships 55
Evidence-Based Teaching Approaches for Informatics 56
Example of Education Efforts 57
Summary for Evidence-Based Curricula and Teaching
Aproaches 57
Strategy Five: Developing Faculty as Teaching/Learning Experts 59
Current Status of Faculty Informatics Competencies 59
A Collaborative Model 60
Incentives to Encourage Faculty Expertise 61
Summary for Faculty Development 62
Summary of Review of Related Literature 62
Chapter Three: Methods 66
Methods for Research Questions 66
Selection of Case Studies 67
Characteristics of Case Study Sites 68
Gaining Access to Study Sites 69
Assuring Protection and Addressing Ethical Issues 69
Participant Selection 70
Data Collection and Storage 71
Document Review 71
Interviews 71
Design of Interview Questions 72
Opening Questions 72
Initial Questions Regarding Healthcare Informatics 72
First and Second Research Questions 73
Third Research Question 73
Fourth Research Question 73
Closing Question 74
Interview Guide Approach 74
Tape Recording of Interviews 74
Field Notes 75
Data Analysis 76
Computer-Assisted Qualitative Data Management and Analysis 76
Logical Analysis 76
Content Analysis 76
Convergence 7
Test for Completeness 77
Divergence 78
Determining Substantive Significance 78
Trustworthiness and Transferability of Study Data and Findings 79
Chapter Four: Research Findings 82
Findings at University of Kansas School of Nursing 82
Introduction 82
i
Research Question One: How is Healthcare Informatics Core
Competency Addressed? 83
Research Questions Two and Three: What Strategies Were Used,
and Why They Were Selected? 85
Culture of Innovation at University of Kansas School of Nursing 85
Academic-Business Partnership 87
Attention to Academic Culture 89
The Role of Sensemaking 91
Academic Template Created Prior to Involving Faculty 92
Electronic Health Record Designed as a Teaching Platform 92
Existing Case Scenarios Computerized 93
Pilot Program began Fall 2001 95
Electronic Health Record Combined with Patient Simulator 97
Common Language and Core Competencies 98
Center for Healthcare Informatics Announced 100
In Summary 102
Core and Supporting Strategies 103
Core Strategy: Senior Administrative Support 104
In Summary 107
Core Strategy: Collaborative Leadership 107
In Summary 109
Core Strategy: Staff Development 110
In Summary 112
Core Strategy: Flexible Vision 112
In Summary 115
Core Strategy: Visible Action 115
Demonstrating Balance 116
Research Question Four: Is University of Kansas School of
Nursing Approaching the Shift to Healthcare
Informatics as the Broad and Deep Change in Values,
Culture and Structures that Would Characterize a
Transformational Change? 117
Findings at Large State University College of Nursing 121
Introduction 121
Research Question One: How is Healthcare Informatics Core
Competency Addressed? 122
Research Questions Two and Three: What Strategies Were Used,
and Why They Were Selected? 124
Nursing Informatics Expert Recruited 124
College of Nursing Receives a Federal Grant 125
Faculty Response to Healthcare Informatics Initiative 126
The Role of Sensemaking 129
Grant Year One 131
Electronic Health Record Provider Chosen 131
Structure to Oversee Grant Activities 131
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Grant Year Two 132
Informatics Content and Technology Implemented in
Medical-Surgical and Critical Care Courses 132
Patient Case Scenarios Loaded into the Electronic Health
Record 13
Nursing Informatics Competencies Established 134
Faculty Education and Development 135
Grant Year Three 136
Pedagogy 137
Student Learning and Assessment Practices 137
In Summary 139
Core and Supporting Strategies 142
Core Strategy: Senior Administrative Support 142
In Summary 143
Core Strategy: Collaborative Leadership 143
In Summary 145
Core Strategy: Staff Development 145
In Summary 146
Core Strategy: Flexible Vision 146
In Summary 148
Core Strategy: Visible Action 148
In Summary 148
Demonstrating Balance 149
Research Question Four: Is Large State University Approaching
the Shift to Healthcare Informatics as the Broad and Deep
Change in Values, Culture and Structures that Would
Characterize a Transformational Change? 150
In Conclusion 153
Findings at Saint Scholastica School of Nursing 155
Introduction 15
Research Question One: How is the Healthcare Informatics Core
Competency Addressed? 156
Research Questions Two and Three: What Strategies Were Used,
and Why They Were Selected? 159
Faculty Subgroup One: Revision of the Undergraduate
Nursing Curriculum 160
Faculty Subgroup Two: Implementation of Healthcare
Informatics Competencies 160
Attention to Academic Culture 161
Strategies Employed in Academic Year 2002-2003 165
Healthcare Informatics 165
Infrastructure Established 165
Undergraduate Nursing Curricula 165
Review of Undergraduate Nursing Curricula 165
Strategies Employed in Academic Year 2003-2004 165
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Healthcare Informatics 165
Faculty Lead Selected and Trained 165
Electronic Documentation Tools Created for Allied Health
Profesions 16
Undergraduate Nursing Curriculum 166
Outside Consultant Engaged 166
Active Learning Pedagogy Approach to Curricula Revision
Begun 16
Strategies Employed in Academic Year 2004-2005 167
Healthcare Informatics 167
Electronic Health Record Used in One Course 167
Request to Load Case Scenarios into Electronic Health
Record Received 168
Center for Leadership and Innovation in Healthcare
Established 169
Undergraduate Nursing Curricula 170
Generalist Curricula Approach Selected 170
Strategies Employed in Academic Year 2005-2006 171
Healthcare Informatics 171
Alumni Health Records Loaded into Electronic Health
Record 171
First Contract Signed for ATHENS Subscription Service
Signed 172
Undergraduate Nursing Curricula 172
Electronic Health Record and Other Components Linked 172
Strategies Employed in Academic Year 2006-2007 173
Healthcare Informatics 173
Two Technologies Integrated 173
Title III-A Grant Objectives Accomplished 174
Undergraduate Nursing Curricula 174
New Undergraduate Nursing Curricula Phased In 175
In Summary 177
The Role of Sensemaking 178
In Summary 180
Core and Supporting Strategies 181
Core Strategy: Senior Administrative Support 181
In Summary 184
Core Strategy: Collaborative Leadership 184
In Summary 185
Core Strategy: Staff Development 186
In Summary 189
Core Strategy: Flexible Vision 189
In Summary 192
Core Strategy: Visible Action 193
In Summary 193
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